Lung Cancer / Pulmonary Embolism / Pleural Effusion Flashcards by Delia Archer

Pallor 
Severe Dyspnea
Right Sided Heart Failure
Crushing Chest Pain
Low Grade Fever
What respiratory disorder has these signs and symptoms?

Pulmonary Embolism

How well did you know this?

Not at all

Perfectly

Which is more difficult to treat Non-Small Cell Lung Cancer or Small Cell Lung Cancer?

Small Cell Lung Cancer is more difficult to treat.

How well did you know this?

Not at all

Perfectly

What test is used to diagnose a pulmonary embolism?

D-Dimer Test

How well did you know this?

Not at all

Perfectly

Finish the Nursing Diagnosis for a patient with Pulmonary Embolism?
Impaired Gas Exchange R/T

Reduced Perfusion

How well did you know this?

Not at all

Perfectly

__________ is the #1 cancer killer of men and women in the United States.

Lung Cancer

How well did you know this?

Not at all

Perfectly

Maintain IV access: Administer IV medications
Limit Activity R/T to lack of oxygen
[Tx: Patient needs frequent rest periods]
These are independent nursing interventions for what respiratory disorder?

Pleural Effusion

How well did you know this?

Not at all

Perfectly

EKG monitoring
Thrombolytic surgery
These are collaborative nursing interventions for what respiratory disorder?

Pulmonary Embolism

Study Tip: EKG monitoring is to monitor for Right Sided Heart Failure.

How well did you know this?

Not at all

Perfectly

Oxygen Therapy
Spiral CT
V/Q Scan
ABGs
These are collaborative nursing interventions for what respiratory disorder?

Pulmonary Embolism

How well did you know this?

Not at all

Perfectly

One cell is transformed and mutated in the tracheo-bronchial airways. One cell mutates and can cause this disease. If the immune system is not effective in destroying these mutated cells the abnormal cell continues to pass on the cellular abnormalities to daughter cells spreading the disease.
What respiratory disorder does this cause?

Lung Cancer

How well did you know this?

Not at all

Perfectly

Chest X-Ray
Chest CT
Sputum Cytology Via Bronchoscopy (to collect cells to study) 
PET Scan
Ultrasound
CT Scan
MRI
These are diagnostic tests to diagnose what respiratory disorder?

Tests for Lung Cancer

How well did you know this?

Not at all

Perfectly

What is the number one cause of lung cancer?

Inhaled Carcinogens

Study Tip: Lung cancer is 10x more common in cigarette smokers.

How well did you know this?

Not at all

Perfectly

How do you diagnose the cause of a pleural effusion?

Thoracentesis

How well did you know this?

Not at all

Perfectly

Monitor PT/INR and PTT levels

These are independent nursing interventions for what respiratory disorder?

Pulmonary Embolism

How well did you know this?

Not at all

Perfectly

Where does Invasive Carcinoma usually occur?

It occurs commonly where there is areas of damage or scarring in the lungs such as patients with tuberculosis and fibrosis.

How well did you know this?

Not at all

Perfectly

What is a collaborative intervention to treat anxiety and pain in a patient with a Pulmonary Embolism?

Administer analgesics like morphine for pain and anxiety.

How well did you know this?

Not at all

Perfectly

This is caused by an over production of fluid or an accumulation of fluid in the pleural space. This is NOT a primary disease. This disease is normally a secondary disease because it is caused by another disorder that is occuring. What respiratory disorder does this cause?

Pleural Effusion

How well did you know this?

Not at all

Perfectly

www.cancer.org talks about both types of cancer

See Website

How well did you know this?

Not at all

Perfectly

Anything that interferes with secretion and absorption of pleural fluid by the capillaries and lymphatic drainage system.
What respiratory disorder does this cause?

Pleural Effusion

How well did you know this?

Not at all

Perfectly

With this respiratory disorder there is a classic triad of symptoms:
Dyspnea
Chest pain
Hemoptysis
What respiratory disorder has these signs and symptoms?

Pulmonary Embolism

Study Tip: Only seen in 20% of patients

How well did you know this?

Not at all

Perfectly

PET Scan
Ultrasound
CT Scan
MRI
These are diagnostic tests to diagnose what respiratory disorder?

Tests for Lung Cancer Metastasis

How well did you know this?

Not at all

Perfectly

What can cause changes in severity of signs and symptoms of lung cancer?

Severity of symptoms depend on location and size of the tumor and how much occlusion is occuring.

How well did you know this?

Not at all

Perfectly

Keep patient on bedrest if you suspect this respiratory disorder but get them moving if you are trying to prevent this respiratory disorder. Elevate the head of the bed.
These are independent nursing interventions for what respiratory disorder?

Pulmonary Embolism

How well did you know this?

Not at all

Perfectly

Monitor VS
Assess respiratory system for what three things?
Administer analgesics for pain. ATC. GIVE MEDS FREELY.
These are independent nursing interventions for what respiratory disorder?

Lung Cancer

Study Tip:
Assess respiratory system: Cough / Sputum Production / Shortness Of Breath

How well did you know this?

Not at all

Perfectly

When you assess the respiratory system of a patient with lung cancer what are you monitoring?

Cough
Sputum Production
Shortness Of Breath

How well did you know this?

Not at all

Perfectly

Massive Embolism can cause sudden circulatory collapse in a patient with shock which causes DEATH. What respiratory disorder has these signs and symptoms?

Pulmonary Embolism

_____________ occur because lung cancer tissues secrete substances which can cause negative effects in the body. These substances can cause SIADH and Pleural Effusion.

Paraneoplastic Syndromes

Pleural fluid is usually absorbed by the visceral pleural capillaries and _________ system.

Lymphatic

How much fluid is normally in the pleural space surrounding the lungs?

Normally there are 15mL of fluid in the pleural space.

Patient with Low Protein Intake Lab: Low Protein Level These are red flags that will tell you that the cause of your Pleural Effusion is?

Transudative Cause [Non-Inflammatory Condition] Study Tip: There is a low protein content because protein is only present in signs of infection which is an inflammatory process.

Re-Position the patient to what position? Elevate the head of the bed to aid with lung expansion. These are independent nursing interventions for what respiratory disorder?

Pulmonary Embolism High Fowler's

____________ occurs as a result of the substances secreted by lung cancer tissues causing alterations in the mechanism that alters the fomation and reabsorption of pleural fluid in the lungs which can lead to excess fluid which can decrease space in the pleural sac for the lung.

Pleural Effusion

What does Empyema mean in relation to a Pleural Effusion?

This is the infusion of both infectious material and pus in the pleural spaces due to an infection.

Tumors Air Fat What respiratory disorder does this cause?

Pulmonary Embolism

Small Cell Lung Cancer metastasizes to what 4 organs very rapidly?

Brain Bone Adrenal gland Liver

Where does a pulmonary embolism occur?

Blood clot gets lodged in the pulmonary arteries feeding deoxygenated blood into the lungs for oxygenation.

``` Non-surgical interventions Ex. ? Chemotherapy Therapy Radiation Therapy Surgical Removal These are collaborative nursing interventions for what respiratory disorder? ```

Lung Cancer Medication/Chemo/Radiation are non surgical

Signs of Infection | This is a red flag that will tell you that the cause of your Pleural Effusion is?

Exudate Causes [Inflammatory Condition]

Pleuritic pain Decreased chest wall movement on the affected side What respiratory disorder has these signs and symptoms?

Pleural Effusion

A-fib in the right side of the heart may lead to a this disorder. The left side of the heart leads to _______? What respiratory disorder does this cause?

Pulmonary Embolism CVA

What is the most common sign of lung cancer?

It starts with a cough that goes from intermittent to chronic. Study Tip: Lung Cancer patients are ASYMPTOMATIC they might not notice the cough is chronic symptoms until its too late. Most patients just assume the cough is related to cigarette smoking.

When the fluid in the syringe is Clear to Light Yellow after a thoracentesis what is the cause of the pleural effusion?

Transudative Cause it is clear because it has a Low Protein Content)

``` Dyspnea Cough Pleuritic pain Decreased chest wall movement on the affected side Dullness on percussion Fever Weight loss Night sweats What respiratory disorder has these signs and symptoms? ```

Pleural Effusion with Infectious Fluid Study Tip: Dyspnea can be unnoticed by the patient because it progresses gradually over time. Dullness on percussion is related to the large amount of fluid retained in the lungs.

``` Major operations: Abdominal Surgery Pelvic Surgery Hip Surgery Knee surgery. What respiratory disorder does this cause? ```

Pulmonary Embolism

How do you determine if a patient is lacking ventilation or perfusion when using a V/Q Scan?

If you could see any blank spaces that would show areas lacking in ventilation or perfusion becuase of death related to pulmonary embolism or lung cancer.

Finish the Nursing Diagnosis for a patient with Pleural Effusion? Impaired Gas Exchange R/T

Lung Collapse

Finish the Nursing Diagnosis for a patient with Pleural Effusion? Ineffective Airway Clearance R/T

Compressed Airways

Assess breath sounds every 4 hours Administer Oxygen [Hyperoxygenation] What position do you put the patient in? These are independent nursing interventions for what respiratory disorder?

Pleural Effusion High Fowler's

Collaborative Care of a patient with Pleural Effusion is aimed at treating the underlying cause which could be one of what four causes? Are these causes Exudative or Transudative?

Heart Failure [R/T increased systemic hydrostatic pressure causing fluid to leak from the intravascular into the interstitial. Transudative Cause] Right Sided Heart Failure [R/T increased pulmonary arterial pressure causing fluid to leak from the capillary beds in the lungs. Transudative Cause] Empyema [R/T accumulation of respiratory infection secretions in the pleural space. Exudative Cause] Malignant Tumor [R/T blockage of lymphatic drainage ducts or blood vessels. Transudative Cause]

Small Cell Lung Cancer has more _______ than Non-Small Cell Lung Cancer.

Negative Outcomes

Pleural Effusion is known as Fluid in the lungs. Where is the fluid Located?

This occurs in the pleural space surrounding the lung between the parietal and visceral pleura.

If the patient has Pleural Effusion R/T Heart Failure recommend that the Doctor orders _________ to treat the underlying cause.

Sodium Restriction and Diuretics

Pulmonary Embolisms occur because of clots that break off from thrombi in arteries. These clots usually originate in what 4 arteries?

Calf Arteries Femoral Arteries Popliteal Arteries Ileac Arteries

Increased systemic hydrostatic pressure Reduced capillary oncotic pressure These are red flags that will tell you that the cause of your Pleural Effusion is? What is the etiology of the red flags?

Transudative Cause [Non-Inflammatory Condition] 1. caused by heart failure 2. caused by low protein level

____________ occurs as a result of the substances secreted by lung cancer tissues causing too much anti-duretic hormone to be released causing the patient to retain too much fluid because of the inability to release fluid in the urine.

Syndrome of Inappropriate Anti-Diuretic Hormone [SIADH]

Heart Failure Tuberculosis Pneumonia These comorbidities are often seen as these underlying cause in patients diagnosed with what respiratory disorder?

Pleural Effusion

Administer Oxygen to make up for areas lacking oxygenation or perfusion. IV access: Why are IVF given? These are collaborative nursing interventions for what respiratory disorder?

Pulmonary Embolism Dilutes the blood to decrease clot formation.

What type of lung cancer is seen in 70% of the population?

Non-Small Cell Lung Cancer

If the patient has Pleural Effusion R/T an Empyema recommend that the Doctor orders _________ to treat the underlying cause.

Chest Tube is inserted to drain infectious material from the space and antibiotic therapy.

If the patient has Recurring Pleural Effusion recommend that the Doctor orders _________ to prevent the problem from coming back indefinitely.

Pleurodesis

What is a pleurodesis?

An irritating substance is injected through a chest tube into the pleural space and the patient is rotated by the nurse so the fluid covers the entire lung. The substance irritates the plueral space and visceral space causing the membranes to touch and fuse together to get rid of the space preventing future pleural effusions.

What are the names of the medications used to irritate the lung to perform a pleurodesis?

Talc Vibromyocin Veblomyacin

What is a Thoracentesis used to treat?

Thoracentesis is done to evacuate fluid from the pleural space thus increasing lung space and to determine the cause of the pleural effusion.

How do you as a nurse perform a Thoracentesis?

Stand in front of the patient and/or their tray table in case the patient gets lightheaded while the Doctor performs the procedure.

What are 5 examples of inhaled carcinogens?

``` Cigarette Smoking Radon Gas Asbestos Coal Dust Arsenic ```

How do you determine the correct location for a thoracentesis?

Chest X-Ray determines beforehand where the fluid is and where the needle needs to be placed. Catheter is placed and the fluid is drained. Study Tip: X-rays of the chest reveal opacification (white areas) of the base of the lung compatible with fluid retention. If this opacification “layers out” when the patient rests on one side, fluid is present. Fluid can also be identified with ultrasound, CT, or MRI of the thorax.

Is a thoracentesis painful?

Should be a painless procedure with only mild discomfort.

Define Pulmonary Embolism?

Pulmonary arteries feeding the alveoli get occluded by an embolus.

Can someone die from a pulmonary embolism?

Yes. A Pulmonary Embolism can be lethal. | 200,000 out of 500,000 diagnosed with it die.

Damage caused by lung cancer results in cellular changes, abnormal cell growth and becomes a malignant cell that reproduces and passes the cellular abnormalities to the daughter cells. DNA changes and becomes unstable. Epithelium in pulmonary system changes and it then becomes _________. It occurs commonly where there is areas of damage or scarring in the lungs such as patients with tuberculosis and fibrosis.

Invasive Carcinoma

What diagnostic lab test can be elevated by any condition that causes fibrin to be degraded such as patients with cancer, infection, and surgery.

D-Dimer Test

What does a V/Q Scan Measure?

Ventilation and Perfusion of the patients lungs.

What Does a Pulmonary Embolism Look Like at the Pulmonary Artery Level?

Occlusion in the blood vessels that surround the alveoli. Leads to hypoxia.

By the time this type of cancer is diagnosed it has metastasized to the brain in 70% of the patients diagnosed.

Small Cell Lung Cancer

Signs and Symptoms may be subtle and non-specific. Diagnosis can be difficult. What respiratory disorder has these signs and symptoms?

Pulmonary Embolism

``` Tachypnea Anxiety Hypoxemia Apprehension Sense of impending doom What respiratory disorder has these signs and symptoms? ```

Pulmonary Embolism Study Tip: Hypoxemia is dependent on the size of the clot. A large clot can fill a larger vessel causing a bigger area of blockage.

D-Dimer Level is Increased | What respiratory disorder has these signs and symptoms?

Pulmonary Embolism

How is a V/Q Scan performed?

Patient gets inhalation radiation and IV radiation. One Image is Ventilation. One Image is Perfusion.

Lung cancer occurs commonly in what areas in the lungs?

Areas of damage or scarring in the lungs Ex. Patients with previous history of Tuberculosis and Fibrosis.

Why is lung cancer difficult to diagnose?

Lung cancer is asymptomatic until late in the course if it occurs in the peripheal bronchioles and not the terminal brnchioles.

Finish the Nursing Diagnosis for a patient with Pulmonary Embolism? Anxiety R/T

Inability to Breath

Prevention is Key. Especially in Surgical Patients. Treatment: Increase activity > Lack of activity increases risk of this disorder. Increasing activity through movement and range of motion is a preventative action. These are independent nursing interventions for what respiratory disorder?

Pulmonary Embolism

When a patient has a Pulmonary Embolism they are put on Anticoagulation Therapy. These patients are given ________ or _________ then later that prescription is changed to _________ for 3-6 months.

Heparin Lovenox Coumadin

Administer thrombolytic medications | These are collaborative nursing interventions for what respiratory disorder?

Pulmonary Embolism

Stay calm & stay with patient to decrease anxiety Assess VS What should your Respiratory assessment include? These are independent nursing interventions for what respiratory disorder?

Pulmonary Embolism Lung Sounds, Vital Signs, 02 Saturation, and Pulse Oximetry

Collaborative Care is Directed at preventing further embolisms such as prevent a _______ from becoming an emboli.

DVT

``` Productive cough Dyspnea Hemoptysis Fever Chest and Shoulder pain Hoarseness Weakness Anorexia Weight Loss What respiratory disorder has these signs and symptoms? ```

Advanced lung cancer Study Tip: Fever is caused by an infection in area distal to the tumor. Anorexia/Weakness/Weight Loss are caused by the patient being in a hyper metabolic state. 60-75% of patients with advanced lung cancer have these symptoms.

Non-Small Cell Lung Cancer and Small Cell Lung Cancer forms of cancer are called ______ because they look like it under a microscope. These cells are undifferentiated.

Oat Cells

If the patient has Pleural Effusion R/T a Malignant Tumor recommend that the Doctor orders _________ to treat the underlying cause.

Surgery to remove as much of the tumor as possible.

Pleural Effusion usually means that the patient has _________ what type of cancer.

Lung Cancer

What type of lung cancer is seen in 15-20% of the population?

Small Cell Lung Cancer

When the fluid in the syringe is Dark Yellow to Amber after a thoracentesis what is the cause of the pleural effusion?

Exudative cause it is Dark Yellow to Amber because it has a High Protein Content Study Tip: There is a Dark Color because of high concentration bacteria increases the amount of white blood cells in the fluid creating pus.

In a Patient that has pulmonary embolism causing decreased perfusion to the Right Lung what will a V/Q scan show?

One Image: Normal Ventilation in Both Lungs. | One Image: Will Show Lack of Perfusion to the Right Lung.

In less active patients with a Pulmonary Embolism increase IV fluids to ____ of fluids a day unless contraindicated by another condition such as Heart Failure to decease the risk of a pulmonary embolism ocurring.

What medical history will lead you to recommend testing your patient for an invasive carcinoma?

Tuberculosis and Fibrosis patients because of the large areas of damage or scarring in the lung.

Septic thrombi Vegetation on heart valves Endocarditis What respiratory disorder does this cause?

Pulmonary Embolism

Turn Cough Deep Breathing Exercises Use of Incentive Spirometry to measure expiration These are independent nursing interventions for what respiratory disorder?

Pleural Effusion

Pulmonary Angiography Surgical Removal These are collaborative nursing interventions for what respiratory disorder?

Pulmonary Embolism

Re-Positioning to what position? Increased activity as tolerated Referral to Dietary for a High calorie, High protein, High vitamin Diet These are independent nursing interventions for what respiratory disorder?

High-Fowler's Lung Cancer Study Tip: Diet Referral because patient will have decreased appetite but hypermetabolic needs.

Chest Tube Insertion Referral for Psychological Support Medication Orders Administration of Bronchodilators & Corticosteroids These are collaborative nursing interventions for what respiratory disorder?

Lung Cancer

Connective Tissue Disease Pulmonary Embolism Lung Cancer Tumors These comorbidities are often seen as the underlying cause in patients diagnosed with what respiratory disorder?

Pleural Effusion

Dyspnea Cough Dullness on percussion What respiratory disorder has these signs and symptoms?

Pleural Effusion Study Tip: Dyspnea can be unnoticed by the patient because it progresses gradually over time. Dullness on percussion is related to the large amount of fluid retained in the lungs.

``` Moving the patient Giving pain meds monitor VS use therapeutic communication to prevent anxiety proper positioning, correct labeling of specimens. ``` These are collaborative nursing interventions for what respiratory disorder?

Pleural Effusion. | These interventions are for the administration or a pleurodesis treatment.

What kind of diet would the nurse recommend for a patient with Lung Cancer?

High Calorie High Protein High Vitamin

___________ may sometimes improve with diuretic therapy, i.e. with control of heart, kidney, or liver failure which can contribute to increased fluid retention.

Transudative Pleural Effusions

___________ should be removed with a chest tube or with repeated thoracentesis, along with treatment of the underlying cause.

Exudative Pleural Effusions

This is an example of what type of pulmonary effusion? Characterized by affecting lung sections adjacent to areas with pneumonia? What is the treatment?

Parapneumonic Pleural Effusion Exudative Treatment: Antibiotic therapy

This is an example of what type of pulmonary effusion? Characterized by affecting lung sections adjacent to areas with cancer What is the treatment?

Malignant Pleural Effusion Transudative Treatment: Surgical debulking and radiation Chemotherapy

Powder or Tetracycline is the chemical that is used in this treatment _________.

Pleurodesis

Lung Cancer / Pulmonary Embolism / Pleural Effusion Flashcards

(108 cards)